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Diagnostic accuracy, reliability and validity of Childhood Autism Rating Scale in India

World Journal of Pediatrics volume 6, pages 141–147 (2010)Cite this article

Abstract

Background

Since there is no established measure for autism in India, we evaluated the diagnostic accuracy, reliability and validity of Childhood Autism Rating Scale (CARS).

Methods

Children and adolescents suspected of having autism were identified from the unit’s database. Scale and item level scores of CARS were collected and analyzed. Sensitivity, specificity, likelihood ratios and predictive values for various CARS cut-off scores were calculated. Test-retest reliability and inter-rater reliability of CARS were examined. The dichotomized CARS score was correlated with the ICD-10 clinical diagnosis of autism to establish the criterion validity of CARS as a measure of autism. Convergent and divergent validity was calculated. The factor structure of CARS was demonstrated by principal components analysis.

Results

A CARS score of ≥33 (sensitivity = 81.4%, specificity = 78.6%; area under the curve = 81%) was suggested for diagnostic use in Indian populations. The inter-rater reliability (ICC=0.74) and test-retest reliability (ICC=0.81) for CARS were good. Besides the adequate face and content validity, CARS demonstrated good internal consistency (Cronbach’s α=0.79) and item-total correlation. There was moderate convergent validity with Binet-Kamat Test of Intelligence or Gessell’s Developmental Schedule (r=0.42; P=0.01), divergent validity (r=−0.18; P=0.4) with ADD-H Comprehensive Teacher Rating Scale, and high concordance rate with the reference standard, ICD-10 diagnosis (82.52%; Cohen’s κ=0.40, P=0.001) in classifying autism. A 5-factor structure explained 65.34% of variance.

Conclusion

The CARS has strong psychometric properties and is now available for clinical and research work in India.

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Affiliations

  1. Autism Clinic, Child & Adolescent Psychiatry Unit, Department of Psychiatry, Christian Medical College, Vellore, 632 002, Southern India

    Paul SS Russell, Anna Daniel, Sushila Russell, Priya Mammen, Julie S. Abel, Lydia E. Raj, Satya Raj Shankar & Naveen Thomas

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  1. Paul SS Russell
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  2. Anna Daniel
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Correspondence to Paul SS Russell.

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Russell, P.S., Daniel, A., Russell, S. et al. Diagnostic accuracy, reliability and validity of Childhood Autism Rating Scale in India. World J Pediatr 6, 141–147 (2010). https://doi.org/10.1007/s12519-010-0029-y

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Key words

  • autism
  • diagnostic accuracy
  • India
  • reliability
  • validation